Acceptance of Different Self-sampling Methods for Semiweekly SARS-CoV-2 Testing in Asymptomatic Children and Childcare Workers at German Day Care Centers
Authors: Geraldine Engels, Johannes Forster, Andrea Streng, Viktoria Rücker, Paul Rudolph, Franziska Pietsch, Julia Wallstabe, Lars Wallstabe, Maike Krauthausen, Julia Schmidt, Timo Ludwig, Carsten Bauer, David Gierszewski, Jesper Bendig, Sandra Timme, Thomas Jans, Benedikt Weißbrich, Marcel Romanos, Lars Dölken, Peter Heuschmann, Christoph Härtel, Ildikó Gágyor, Marc Thilo Figge, Johannes Liese, Oliver Kurzai, Annsophie Amman, Anastasia Besenfelder, Leonie Bode, Inga Enders, Thiemo Frank, Kathrin Frei, Greta Habersack, Viktoria Hamway, Theresa Höferth, Thiên-Tri Lâm, Sabrina Mündlein, Konstanze Rauch, Christoph Schoen, Timo Spannagel, Fabian Rothbauer, Marianna Abert, Julia Bley, Tatjana Durnev, Carolin Glatzle, Antonia Hardung, Katharina Karch, Sebastian Kollert, Tanja Mastorakis, Lena Schregelmann, Victoria Sokalski, Eva-Lotta Tanzberger, Anne Thieme, Denise Yilmaz, Stefan Zimmerling, Pauline Nehm, Max Siegl, Brigitte Wehner, Kerstin Knies, Rebecca Richter, Hülya Düber, Monika Kraft, Christian Schuchardt, Barbara Finkenberg, Johann Löw
Journal: JAMA Network Open (2022)

Importance Closure of day care centers (DCCs) to contain the COVID-19 pandemic has been associated with negative effects on children’s health and well-being. Objective To investigate the acceptance of self-sampling methods for continuous SARS-CoV-2 surveillance among asymptomatic children and childcare workers (CCWs) in DCCs. Design, Setting, and Participants This nonrandomized pilot study included children and CCWs at 9 DCCs in Wuerzburg, Germany, from May to July 2021. Interventions Twice weekly testing for SARS-CoV-2 was conducted by self-sampled mouth-rinsing fluid (saliva sampling [SAL], with subsequent pooled polymerase chain reaction test) plus nasal rapid antigen self-test (RAgT) (group 1), SAL only (group 2), or RAgT only (group 3) in children and CCWs. Main Outcomes and Measures Main outcomes were rates for initial acceptance and successful (≥60% of scheduled samples) long-term participation. The probability of SARS-CoV-2 introduction into DCCs was modeled as a function of age-adjusted background incidence and DCC size. Results Of 836 eligible children, 452 (54.1%; 95% CI, 50.7%-57.4%) participated (median [IQR] age: 4 [3-5] years; 213 [47.1%] girls), including 215 (47.6%) in group 1, 172 (38.1%) in group 2, and 65 (14.4%) in group 3. Of 190 CCWs, 139 (73.2%; 95% CI, 66.4%-79.0%) participated (median [IQR] age: 30 [25-46] years; 128 [92.1%] women), including 96 (69.1%) in group 1, 29 (20.9%) in group 2, and 14 (10.1%) in group 3. Overall, SARS-CoV-2 PCR tests on 5306 SAL samples and 2896 RAgTs were performed in children, with 1 asymptomatic child detected by PCR from SAL. Successful long-term participation was highest in group 2 (SAL only; children: 111 of 172 [64.5%]; CCWs: 18 of 29 [62.1%]). Weekly participation rates in children ranged from 54.0% to 83.8% for SAL and from 44.6% to 61.4% for RAgT. Participation rates decreased during the study course ( P &amp;amp;lt; .001). The probability of SARS-CoV-2 introduction into a DCC with 50 children was estimated to reach at most 5% for an age-adjusted SARS-CoV-2 incidence below 143. Conclusions and Relevance Self-sampling for continuous SARS-CoV-2 testing was well accepted, with SAL being the preferred method. Given the high number of negative tests, thresholds for initiating continuous testing should be established based on age-adjusted SARS-CoV-2 incidence rates. Trial Registration German Registry for Clinical Trials Identifier: DRKS00025546